2 - Lumbar puncture
To be performed:
• Presentation to the patient
• Identity verification (patient identification)
• Proper patient positioning: patient seated on the edge of the bed, legs dangling or on a chair, back rounded (fetal position, rounded back possible if seated lumbar puncture, impossible or necessary for measuring CSF opening pressure)
• Verify the presence of all equipment
• Explanation of the reason for the procedure
• Explanation of the risks of the procedure: pain at the puncture site, headaches and post-lumbar puncture syndrome, hematomas, infections, lower back pain, paraplegia
• Explanation of the procedure
• Obtaining the patient's verbal consent
• Verifying the absence of contraindications to the procedure (local infection, coagulation disorder, thrombocytopenia below 50 GLI, anticoagulant therapy, cerebral herniation)
• Hand disinfection with hydroalcoholic solution Technical characteristics of the procedure:
Technical characteristics of the procedure
• Disinfection Lower back with chlorhexidine/alcoholic povidone-iodine solution
• Don sterile gloves
• Place a sterile drape
• Locate the reference points: below the horizontal line connecting the two iliac crests
• Select the needle, maximum 22 gauge
• Midline puncture, L3-L4, L4-L5, or L5-S1 interspinous space
• Wait for spontaneous return of CSF
• Fill tubes (as indicated): At least 3, with a minimum of 10 drops per tube
• Remove the needle after replacing the stylet
• Dress the puncture site
• Perform capillary blood glucose testing concurrently with the procedure
Presenter:
Dr. Charles-Hervé VACHERON
Written by:
Dr. Charles-Hervé VACHERON - Anesthesiologist and Intensive Care Specialist
Reviewed by:
Professor Florent VALOUR - Infectious Disease Specialist
Dr. Anne CONRAD - Infectious Disease Specialist